Assessing barriers to post-abortal LARC provision through qualitative interviews
Awarded 2013
Complex Family Planning Fellowship Research
Peggy Ye, MD
Washington Hospital Center

Background: The use of long-acting, highly effective forms of contraception such as the intrauterine device (IUD) or subdermal implant is associated with lower pregnancy and repeat abortion rates.  Immediate post-abortal insertions are safe and effective, yet many abortion facilities in the United States do not offer immediate placement. Previous research has identified patient and provider knowledge deficits, billing and reimbursement difficulties, and work flow constraints as barriers to providing LARC in this setting.
Objectives: Abortion providers in the Washington, DC metropolitan area will be interviewed to identify barriers to post-abortal LARC provision.  This setting was chosen because immediate post-abortal insertions occur in only a few facilities.  In addition, mobility of patients across the borders of Washington, DC, Virginia, and Maryland complicates financial reimbursement issues.
Methods: We are conducting face-to-face interviews of abortion providers and clinic managers using a semi-structured topic guide to explore attitudes and practice patterns towards immediate post-abortal LARC insertion. We are recruiting participants through their affiliation with abortion facilities identified by personal knowledge, internet searches, telephone listings, membership directories, and snowball sampling. Transcribed interviews will then be analyzed using deductive and inductive methods.  Deductively derived themes were determined based on previously published research and additional codes will be added inductively as new themes arise in the interviews.
Expected Results: Currently we have identified 24 facilities from which to recruit participants with two interviews completed. Deductively derived themes, determined a priori, were LARC counseling, follow-up visits, risks of immediate insertion, billing/cost, and clinic flow.  We anticipate that cost to the clinic and detrimental changes to clinic flow will be the primary concerns with immediate post-abortal LARC insertion.  In addition, due to the complex patient flow across Washington, DC’s borders, we expect that complicated billing procedures will exacerbate the cost.
Expected Conclusions: If our hypothesis is substantiated, this study may highlight an area that can be targeted to improve LARC uptake. A pilot intervention may then be designed to increase post-abortal LARC availability at a participating facility.